Department of Medicine, National Jewish Health, Denver, Colo., USA.
J Allergy Clin Immunol. 2013 Mar;131(3):627-34; quiz 635. doi: 10.1016/j.jaci.2013.01.010. Epub 2013 Jan 26.
Asthma and chronic obstructive pulmonary disease (COPD) are prevalent obstructive lung diseases, both of which are characterized by airflow limitation. Although both represent distinct pathogenic entities, there can be significant clinical and physiologic overlap between the 2 disorders, creating potential management difficulties for clinicians. Although practice guidelines for both conditions outline diagnostic and management strategies, asthma and COPD are highly heterogeneous, and the symptoms of many patients remain poorly controlled despite adherence to current guidelines. Recent advances in phenotyping studies have elucidated heterogeneity in these airway diseases and might represent the best opportunity to enhance diagnosis, predict outcomes, and personalize treatments in patients with asthma and those with COPD. This review will focus on recent advances in describing phenotypic heterogeneity in asthma and COPD, including the evaluation of multiple clinical variables, molecular biomarkers, physiologic and radiologic data, and factors associated with disease progression and frequent exacerbations.
哮喘和慢性阻塞性肺疾病（COPD）是常见的阻塞性肺部疾病，两者均以气流受限为特征。尽管这两种疾病代表不同的病理实体，但在这两种疾病之间存在显著的临床和生理学重叠，给临床医生的管理带来了潜在的困难。尽管针对这两种疾病的实践指南都概述了诊断和管理策略，但哮喘和 COPD 高度异质，尽管患者坚持遵循当前的指南，但许多患者的症状仍控制不佳。最近在表型研究方面的进展阐明了这些气道疾病的异质性，这可能是提高哮喘和 COPD 患者诊断、预测结局和实现个体化治疗的最佳机会。这篇综述将重点介绍描述哮喘和 COPD 表型异质性的最新进展，包括评估多个临床变量、分子生物标志物、生理和影像学数据以及与疾病进展和频繁加重相关的因素。
